Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

Thomas Rest Haven

Coon Rapids, IA · 57 certified beds · Last Life Safety survey September 18, 2025

CMS Certification Number 165358 · first certified October 1997

Ownership

Independently operated (no chain recorded by CMS) · Government - City/county

No change of ownership on CMS record since January 1, 2016, when the records begin.

19
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
2
Tags cited more than once
Across separate surveys
2
Inspection & testing records
Of the citations on file

Position within IA

19 citations — more than 82% of the 387 certified nursing homes in IA. Compared within IA rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated

Slippingmore citations at the latest survey than at its earlier surveys in the window.

The latest survey found 0 citations; the earlier surveys in the window averaged 9.5. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

The window is open now: August 2026 to October 2026. This facility’s last Life Safety survey was September 2025. Facilities in IA are typically surveyed 11–13 months after the last one (median 12), measured over 700 consecutive surveys in the last two years of CMS records.

A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured

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Which alerts

Emergency preparedness

11 of the 19 citations on file are Emergency Preparedness E-tags. E-tags are cited under 42 CFR §483.73 and concern the emergency plan, training, drills, communications and supplies. Nationally about half of certified facilities have at least one. The Emergency Preparedness Index

Physical environment (health survey)

5 physical-environment citations on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 19 Life Safety citations above. The Physical Environment Index

  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  • F-0880 Provide and implement an infection prevention and control program.

How that compares

Citations on file over three years

Compared with the median facility in IA, and nationally. Surveyors differ markedly between states, so the IA figure is the meaningful one.

This facility19IA median12National median11
Citations on file over three years, compared
MeasureCitations
This facility19
Median facility in IA12
Median facility nationally11

Survey history

Citations at each Life Safety survey
42023-07152024-1002025-09
Citations at each Life Safety survey
Survey dateCitations
July 27, 20234
October 17, 202415
September 18, 20250

Most-cited tags

Most-cited tags at this facility
E-00392E-00262E-00071K-09231E-00331K-07111K-03741E-00061
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
E-0039Conduct testing and exercise requirements.22024-10-17
E-0026Establish roles under a Waiver declared by secretary.22024-10-17
E-0007Address patient/client population and determine types of services needed.12024-10-17
K-0923Have proper medical gas storage and administration areas.12023-07-27
E-0033Establish methods for sharing information.12024-10-17
K-0711Provide a written emergency evacuation plan.12024-10-17
K-0374Install smoke barrier doors that can resist smoke for at least 20 minutes.12024-10-17
E-0006Conduct risk assessment and an All-Hazards approach.12024-10-17

What the citations cover

Citations by CMS category
  • Emergency Preparedness Deficiencies 11
  • Gas, Vacuum, and Electrical Systems Deficiencies 4
  • Smoke Deficiencies 3
  • Miscellaneous Deficiencies 1
Citations by CMS category
CategoryCitations
Emergency Preparedness Deficiencies11
Gas, Vacuum, and Electrical Systems Deficiencies4
Smoke Deficiencies3
Miscellaneous Deficiencies1

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

October 17, 2024 — 15 citations

Citations issued on October 17, 2024
TagWhat the surveyor checksStatus
E-0004Develop and maintain an Emergency Preparedness Program (EP).Deficient, Provider has date of correction (November 14, 2024)
E-0006Conduct risk assessment and an All-Hazards approach.Deficient, Provider has date of correction (November 20, 2024)
E-0007Address patient/client population and determine types of services needed.Deficient, Provider has date of correction (November 14, 2024)
E-0009Include a process for Emergency Preparedness collaboration.Deficient, Provider has date of correction (November 26, 2024)
E-0015Address subsistence needs for staff and patients.Deficient, Provider has date of correction (November 14, 2024)
E-0024Establish policies and procedures for volunteers.Deficient, Provider has date of correction (November 20, 2024)
E-0026Establish roles under a Waiver declared by secretary.Deficient, Provider has date of correction (November 26, 2024)
E-0033Establish methods for sharing information.Deficient, Provider has date of correction (November 14, 2024)
E-0039Conduct testing and exercise requirements.Deficient, Provider has date of correction (November 14, 2024)
K-0346Follow proper procedures when the fire alarm was out of service for more than 4 hours.Deficient, Provider has date of correction (November 14, 2024)
K-0354Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.Deficient, Provider has date of correction (November 14, 2024)
K-0374Install smoke barrier doors that can resist smoke for at least 20 minutes.Deficient, Provider has date of correction (November 14, 2024)
K-0711Provide a written emergency evacuation plan.Deficient, Provider has date of correction (November 14, 2024)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (November 14, 2024)
K-0921Ensure that testing and maintenance of electrical equipment is performed.Waiver has been granted (November 26, 2024)

July 27, 2023 — 4 citations

Citations issued on July 27, 2023
TagWhat the surveyor checksStatus
E-0026Establish roles under a Waiver declared by secretary.Deficient, Provider has date of correction (September 2, 2023)
E-0039Conduct testing and exercise requirements.Deficient, Provider has date of correction (September 2, 2023)
K-0920Ensure proper usage of power strips and extension cords.Deficient, Provider has date of correction (September 2, 2023)
K-0923Have proper medical gas storage and administration areas.Deficient, Provider has date of correction (September 2, 2023)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.